One to one Coaching Booking Page

One on One Coaching

Pre-Activity Questionnaire / Registration Form

I am delighted that you have chosen one on one coaching with me, I am sure that you will fall in love with the practices and Embody your own Hope and Joy.

All details are kept confidential. Medical information is given to emergency personnel in the case of emergency and kept on record for insurance purposes. You will be contacted with any additional information about the class via email or text. You may also receive occasional emails about upcoming events that might interest you.

You Personal Details

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Phone

(###)

###

####

Additional Information;

Anything you would like me to be aware of before our session.

Authorisation

I have declared any pre-existing medical or mental health conditions; allergies, injuries and medications that may affect me. I understand that there may be physical activity which involves some risk of injury. I hereby release Marjorie Gardiner from the liability arising from injury or loss outside of duty of care.

Please check box, acknowledging the above.

Signature

Please type your name

How did you hear about the private sessions?

Social Media

Word of mouth

Venue

Other

Book an appointment.

Thank you for choosing to book a session with me.

Contact Marjorie

Welcome to Embody Hope and Joy.

Contact me if you have any questions about booking a 1:1 Meditation Coaching.

I can’t wait to connect with you.

Marjorie Gardiner